Ms Roberts, a 33 year-old female, presents with complaints of dull steady pelvic pain and severe lower back pain. Her menses began yesterday and the pain has been continuous since then. Ms Roberts has been experiencing mild menstrual pain at every menstruation since her menarche but the pain has become unbearable over the last four years. Her menstrual flow has become heavy in the last 4 years. Her periods now last for 7 days, with large dark clots and excessive bleeding for the first 4-5 days of menstruation. She feels exhausted after her periods and also complains of overall reduced physical stamina lately. She also experiences painful defecation and intercourse. She also experiences a visual aura, a throbbing and paroxysmal headache, with neck pain and vomiting before her menstruation at least twice-a-year since her menarche. She feels irritated and gets angry for minor issues during her periods.
She has been married for nine years and has no children. She is not using any contraception as she has been trying to conceive for the last two years.
Her Vital signs are recorded please see attached.

Questions: Answer the following questions in not more than 1000 words (+/-10%). The information for answering these questions should be collected from at least four credible sources other than the prescribed readings.

1. List key diagnostic features presented by this patient (3 marks). What further questions would you like to ask to identify likely disease conditions for this patient? (3 marks)
2. Identify three (3) primary disease conditions that could present with signs and symptoms similar to this patient (3 marks). Provide your rationale for selecting each condition. In your answer match the patient’s presentation to the presentation of your chosen conditions. (3 marks)
3. The three conditions that you have chosen above represent the differential diagnosis for this patient. Compare and contrast the clinical signs and symptoms of these three conditions with each other. (6 marks). Note: Here, you are not asked to compare the signs and symptoms of three differential diagnosis with the patient’s signs and symptoms. You are required to compare and contrast all the signs and symptoms of the three conditions with each other irrespective of patient’s presentation.
4. Choose one of the conditions from above as a definitive diagnosis for this patient. Describe in detail the pathophysiology of your chosen definitive diagnosis for this patient (9 marks). Co-relate the pathological mechanism of your chosen definitive diagnosis to the development of signs and symptoms of this patient (5 marks).
5. Discuss three (3) investigation tests that will help to confirm your selection of definitive diagnosis and rule out the other two (3 marks). In your discussion, include the possible expected findings of these investigation tests that will confirm your chosen definitive diagnosis (3 marks).
6. Identify two pharmacological and two non-pharmacological management options for this patient considering your chosen definitive diagnosis (4 marks). Correlate the patient’s presentation and stage of disease to your chosen management options (2 marks).